Study protocol: home-based telehealth stroke care: a randomized trial for veterans.
Abstract
BACKGROUND: Stroke is one of the most disabling and costly impairments of adulthood
in the United States. Stroke patients clearly benefit from intensive inpatient care,
but due to the high cost, there is considerable interest in implementing interventions
to reduce hospital lengths of stay. Early discharge rehabilitation programs require
coordinated, well-organized home-based rehabilitation, yet lack of sufficient information
about the home setting impedes successful rehabilitation. This trial examines a multifaceted
telerehabilitation (TR) intervention that uses telehealth technology to simultaneously
evaluate the home environment, assess the patient's mobility skills, initiate rehabilitative
treatment, prescribe exercises tailored for stroke patients and provide periodic goal
oriented reassessment, feedback and encouragement. METHODS: We describe an ongoing
Phase II, 2-arm, 3-site randomized controlled trial (RCT) that determines primarily
the effect of TR on physical function and secondarily the effect on disability, falls-related
self-efficacy, and patient satisfaction. Fifty participants with a diagnosis of ischemic
or hemorrhagic stroke will be randomly assigned to one of two groups: (a) TR; or (b)
Usual Care. The TR intervention uses a combination of three videotaped visits and
five telephone calls, an in-home messaging device, and additional telephonic contact
as needed over a 3-month study period, to provide a progressive rehabilitative intervention
with a treatment goal of safe functional mobility of the individual within an accessible
home environment. Dependent variables will be measured at baseline, 3-, and 6-months
and analyzed with a linear mixed-effects model across all time points. DISCUSSION:
For patients recovering from stroke, the use of TR to provide home assessments and
follow-up training in prescribed equipment has the potential to effectively supplement
existing home health services, assist transition to home and increase efficiency.
This may be particularly relevant when patients live in remote locations, as is the
case for many veterans. TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT00384748.
Type
Journal articleSubject
Activities of Daily LivingAged
Aged, 80 and over
Community Health Services
Delivery of Health Care, Integrated
Disability Evaluation
Follow-Up Studies
Hospitals, Veterans
Humans
Male
Middle Aged
Outcome Assessment (Health Care)
Patient Satisfaction
Stroke
Stroke Rehabilitation
Telemedicine
Telephone
United States
Veterans
Videotape Recording
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https://hdl.handle.net/10161/4379Published Version (Please cite this version)
10.1186/1745-6215-11-74Publication Info
Chumbler, NR; Rose, DK; Griffiths, P; Quigley, P; McGee Hernandez, N; Carlson, KA;
... Hoenig, H (2010). Study protocol: home-based telehealth stroke care: a randomized trial for veterans.
Trials, 11. pp. 74. 10.1186/1745-6215-11-74. Retrieved from https://hdl.handle.net/10161/4379.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Helen Marie Hoenig
Professor of Medicine
1. General Focus and Goals of Research: Dr. Hoenig's research focuses on rehabilitation,
and more specifically on assistive technology and teletechnology. Patient populations
of interest include geriatric patients with diverse medical problems including stroke,
spinal and/or musculoskeletal disorders. 2. Specific Approaches or Techniques: Randomized
controlled trials, epidemiological studies including large data base analyses and
survey research. Clinical trials include studies of t
Miriam C. Morey
Professor Emeritus of Medicine
The general focus of Dr. Morey's work is exercise and aging. All of her research examines
how physical activity, exercise training, or physical fitness influence the physical
functioning and/or pyschosocial quality of life of older adults. She directs a supervised
hospital-based program for older adults, which is used to examine longitudinally the
effects of exercise training on the musculoskeletal, articular, and cardiorespiratory
systems. Furthermore, she has a number of studies that examine h
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